Māori health snapshot: Follow the data and target inequities

The other day someone mentioned to me that an updated version of Tatau Kahukura was online. I almost couldn’t believe it. It has been 10 years since the last update, and I had given up hope that we’d see a new one any time soon.

Tatau Kahukura, the Māori health chart book, has, since the first edition in 2006, provided a snapshot of the health of Māori compared with non-Māori.

It was originally developed as part of the monitoring He Korowai Oranga (Māori Health Strategy) and as a response to calls for Māori to have access to a wide range of health information that could be easily accessed and easily understood.

Mita Ririnui, the then associate minister with responsibility for Māori health, said in 2006 when the first Tatau Kahukura was released that, as an evidence-based report, it “can provide important clues to understanding the causes of disease and contribute to primary prevention initiatives”.¹

The initial intention was to update the chart book every three years, but this never really panned out. The second edition was published in 2010 and the third in 2015. This fourth edition is dated December 2024. All up, Tatau Kahukura has been going for nearly two decades.

I was thrilled to know there was a fourth edition out in the world, even if it is a few years late. In addition to the data being useful for policy, research and service delivery, access to this data is also important to Māori whānau and communities. As Ngapera Riley wrote in 2023: “The Government holds a large amount of data about Māori that is used in decision-making by both the Government and by Māori. It’s vital that this data continues to be accessible to Māori and that the quality keeps improving.” ²

And, as it has been 10 years since the last chart book, it was time to provide more up-to-date data. However, there has also been ample opportunity for the book to expand – perhaps including more comprehensive data or better reflecting whānau health aspirations. This new edition, with the exception of results from the Active NZ survey, actually provides less comprehensive data than previously because there is no updated data on disability.

You can read the chart book on the Ministry of Health website – as with the previous editions it is easy to scan and understand.³ But I do want to highlight some key results.

• Population: In 2023, Māori made up 17 per cent of the New Zealand population (up from 15.6 per cent in 2013, which is the data used in the previous edition). The Māori population is younger overall than the non-Māori population and is expected to reach over 1,000,000 people by 2030 (in 2023 there were just over 900,000 Māori in the country).
• IMPB rohe: The iwi Māori partnership board rohe with the largest Māori population is Te Taumata Hauora o Te Kahu o Taonui, which runs north from the Tāmaki Estuary to Te Rerenga Wairua, with 185,500 Māori (it is also the IMPB with the highest total population). The highest proportion of Māori is in the Tairāwhiti Toitū te Ora rohe, where Māori make up 56 per cent.
• Discrimination: Māori experience higher levels of racial discrimination than non-Māori. The new chart book reports that 36.5 per cent of Māori have experienced ethnically motivated personal attacks or unfair treatment on the basis of ethnicity. This is based on data from 2020/21 and is higher than the levels reported in 2015 (when only 27.5 per cent of Māori reported such discrimination). There is gender dimension to this too, with, for example, Māori women four times as likely to have experienced unfair treatment by a health professional as non-Māori women.
• Life expectancy: There remains an unfair and unjust life expectancy gap of 7.5 years for Māori males compared to non-Māori males and 7.3 years for Māori females compared with non-Māori females. In both cases this is a slightly bigger gap than was reported in 2015, so things are moving in the wrong (and, honestly, upsetting) direction.
• Vaccination: Things are also trending in the wrong direction for immunisation. Immunisation rates are down from 2015 when 88.9 per cent of pēpi Māori were fully immunised at eight months. Now, only 69.7 per cent of pēpi Māori are fully immunised at eight months and there’s a widening gap between Māori and non-Māori babies (with 88.6 per cent of non-Māori babies fully immunised at the same age).

It’s not exclusively bad news, but the good news is not unambiguous. For example, smoking rates are down for Māori adults (15 years and older) with only 20.6 per cent (compared with 42 per cent in the 2015 book) identified as daily smokers. This needs to be interpreted with caution, though, as for the first time we have vaping rates in Tatau Kahukura and the vaping rate for Māori adults is 26.1 per cent, compared with 10.3 per cent for non-Māori.

When it comes to primary healthcare, there are consistent patterns of unmet need for Māori children and adults. While unmet need in general is similar for Māori and non-Māori children, Māori children are four times as likely as non-Māori to have unmet need for a GP due to lack of transportation. And Māori adults are one-and-a-half times more likely than non-Māori to have unmet need for primary healthcare due to owing their clinic money, and are twice as likely as non-Māori to report not collecting their prescriptions.

Now that we have this data, so what? In addition to it being valuable to have a point-in-time record to hold government to account, this type of data can also be used in informing government policy and investment. This is particularly the domain of the Social Investment Agency, which seeks “to improve outcomes for people through the systematic, consistent, and rigorous use of data and evidence to invest earlier and more effectively”.⁴ While I don’t think the data in the chart book would by itself provide enough nuanced detail, especially without any disability data, it does give us hints about where to start further exploration (eg, addressing discrimination, improving access to primary healthcare, and increasing access to transportation).

For the Government, which has been clear that its social investment programme of work is meant to help tailor and target interventions “rather than waiting for the inevitable crisis”,⁵ Tatau Kahukura is surely a reminder that it must not ignore inequitable differences in health status and outcomes for Māori compared with non-Māori. Such inequities require health and social sector responses that centre on Māori needs and aspirations. To do otherwise would be to fly in the face of the data-driven approach it claims to value.

With this in mind, I turn to a speech from minister for social investment Nicola Willis, speaking on that topic, from November 2024: “Those of you who interrogate the data know what we need to be focusing on and what we need to be trying, and you know how we should be thinking about what success looks like.” ⁶

Those who interrogate Tatau Kahukura will inevitably see that success looks like a vastly different snapshot to what we have had for the past 20 years. While everyone might suggest different areas of specific focus, it’s hard to imagine that a one-size-fits-all approach, or one that is ignorant of the impacts of racism, will get us close to success.

Gabrielle Baker (Ngāpuhi, Ngāti Kuri) is an independent health policy consultant